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Friday, July 13, 2012

This week, Alnylam presented data for its hemophilia program which aims at providing particularly those patients that have developed antibodies ('inhibitors') against the recombinant factor VIII and IX standard-of-care with a treatment alternative. After ALN-TTR for TTR amyloidosis, this is the second of the
two programs the company wants to focus its internal development resources on. The presentation, however, showed that the timelines have been delayed due to a change in target gene selection. So with an IND planned for this program in 2013, it thus appears that the original 5x15TM, which stated that the company wanted to move 5 clinical candidates into late-stage development by 2015, is more and more turning into a ‘1 out of 5’- if all goes well. What a difference 18 months can make!

Sarcasm aside, the reason for the change in target gene
selection is due to modeling the impact of various degrees of gene knockdown on
the desired biological outcome: a 50% knockdown of antithrombin (AT) goes much
further in terms of thrombin generation (the biomarker used in the study) than
a 50% knockdown of the target gene in ALN-APC, protein C.

The type of detailed genetic analysis behind this
realization is actually a very important one that companies should think more about
when selecting RNAi target genes. All
too often, target gene selection is based on classical black-and-white gene
knockout genetics which can be misleading.
Indeed, the VEGF component in ALN-VSP02 may be one of those.

In the presentation, Alnylam further emphasized that ALN-AT3 utilizes a
conjugate-siRNA approach amenable to subcutaneous administration. Although the hemophilia community is very
familiar with the intravenous route of drug administration, the company
essentially claims that this is ‘a highly
preferred mode of administration in the setting of hemophilia’.

Really? In any case, adopting GalNac-siRNA conjugation as an alternative to the gold-standard SNALP delivery would also make strategic sense for Alnylam. Alnylam has become overly dependent on Tekmira’s technology to the extent that it apparently/allegedly felt compelled to mis-appropriate the technology which is subject to a high-profile ongoing litigation. Not a good
position to be in when the supplier (and owner) of that technology could pull
the plug any day.

On the other hand, the scientific evidence, particularly the shallow dose response in non-human primates which suggest that antisense-type large amounts of drug would be needed (3-10mg/kg), suggest that just maybe GalNac conjugation is not ready yet for prime time. .

interesting...hadn't gotten around to perusing the ALNY hemophilia data presentation. You'd think they would have at least started to talk about the second target in presentations ahead of time to soften the blow. What a mess (as I've been documenting for awhile) the 5x15 has been from the moment it left the consultant's slide deck

TTR lowering is in a way a biomarker accepted by the medical community for the treatment of TTR amyloidosis based on the use of liver transplantations in this disease. Although some kind of neuropathic score may be eventually required for the full regulatory approval of a TTR lowering agent, it would be interesting to speculate that for preliminary approval simple TTR lowering may suffice (in the FAP setting i.e.).

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